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1.
Khirurgiia (Mosk) ; (5): 95-100, 2024.
Article in Russian | MEDLINE | ID: mdl-38785244

ABSTRACT

A personalized approach with attention to anamnesis and specific symptoms is necessary in patients with internal carotid artery tortuosity. Neuroimaging (especially before elective surgery) or functional stress tests following ultrasound of supra-aortic vessels may be necessary depending on medical history and complaints. In addition to standard Doppler ultrasound, these patients should undergo rotational and orthostatic transformation tests. We analyze changes in shape and hemodynamic parameters within the tortuosity area in various body positions. This is especially valuable for patients with concomitant carotid artery stenosis. The article presents a clinical case illustrating the importance of such approach.


Subject(s)
Carotid Artery, Internal , Carotid Stenosis , Humans , Arteries/abnormalities , Atherosclerosis/complications , Atherosclerosis/diagnosis , Atherosclerosis/physiopathology , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/abnormalities , Carotid Artery, Internal/physiopathology , Carotid Stenosis/physiopathology , Carotid Stenosis/complications , Carotid Stenosis/diagnosis , Carotid Stenosis/surgery , Hemodynamics/physiology , Joint Instability , Skin Diseases, Genetic , Ultrasonography, Doppler/methods , Vascular Malformations/diagnosis , Vascular Malformations/complications , Vascular Malformations/physiopathology
2.
Khirurgiia (Mosk) ; (5): 146-151, 2024.
Article in Russian | MEDLINE | ID: mdl-38785251

ABSTRACT

The review is devoted to diagnosis and treatment of internal carotid artery tortuosity. The authors consider modern classification, epidemiology and diagnostic options using neuroimaging or ultrasound-assisted functional stress tests depending on medical history and complaints. In addition to standard Doppler ultrasound, rotational and orthostatic tests are advisable due to possible changes of local shape and hemodynamic parameters following body position changes, especially in patients with concomitant atherosclerotic stenosis. Thus, a personalized approach is especially important for treatment and diagnostics of internal carotid artery tortuosity.


Subject(s)
Carotid Artery, Internal , Humans , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/abnormalities , Carotid Artery, Internal/physiopathology , Atherosclerosis/diagnosis , Atherosclerosis/complications , Atherosclerosis/physiopathology , Carotid Stenosis/physiopathology , Carotid Stenosis/complications , Carotid Stenosis/diagnosis , Ultrasonography, Doppler/methods , Vascular Malformations/diagnosis , Vascular Malformations/physiopathology , Vascular Malformations/complications , Arteries/abnormalities , Joint Instability , Skin Diseases, Genetic
3.
Khirurgiia (Mosk) ; (12): 83-88, 2023.
Article in Russian | MEDLINE | ID: mdl-38088844

ABSTRACT

Phantom pain syndrome significantly impairs the quality of life and effectiveness of surgical treatment after limb amputations. The authors consider possible strategies for treatment and prevention in elective surgical intervention and mine-explosive injuries.


Subject(s)
Explosive Agents , Phantom Limb , Humans , Phantom Limb/diagnosis , Phantom Limb/etiology , Phantom Limb/prevention & control , Quality of Life , Amputation, Surgical
4.
Article in Russian | MEDLINE | ID: mdl-38289312

ABSTRACT

Postoperative pain is a pressing medical problem, as it significantly reduces the quality of life of patients after surgical treatment. Chronic postoperative pain further disables patients and impairs their functional activity. Being a widespread interdisciplinary problem, postoperative pain requires the integration of various pain management methods in complex multimodal pain management in the acute period and treatment programs for its chronicity. The paper examines the possibilities of reflexology methods for the relief of acute and treatment of chronic postoperative pain. Integration of reflex effects from the first days after surgery makes it possible to more effectively and safely solve the problems of acute and chronic postoperative pain.


Subject(s)
Musculoskeletal Manipulations , Quality of Life , Humans , Pain Management , Pain, Postoperative/etiology , Pain, Postoperative/therapy
5.
Khirurgiia (Mosk) ; (6. Vyp. 2): 84-88, 2021.
Article in Russian | MEDLINE | ID: mdl-34032793

ABSTRACT

The problem of chronic postoperative pain has been actualized for the last 20 years all over the world. At least 10-40% of patients suffer from chronic pain after surgery. This review is devoted to the current state of the problem of chronic postoperative pain, risk factors and prediction of chronic pain. The authors emphasize the need for interdisciplinary approach to prevention and treatment of this adverse event.


Subject(s)
Pain, Postoperative , Humans , Pain, Postoperative/diagnosis , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control
6.
Article in Russian | MEDLINE | ID: mdl-33834714

ABSTRACT

OBJECTIVE: To estimate the frequency of early postoperative neurological complications in patients undergoing planned surgery on the ascending aortic and arch of the aorta, and their long-term outcomes. MATERIAL AND METHODS: The prospective study included 100 patients who were operated on at the FSBSI Petrovsky Russian Research Center of Surgery. In group I (n=50), operations were performed on the aortic arch with hypothermic circulatory arrest (26 °C) and antegrade cerebral perfusion. Patients in group II underwent prosthetics of the ascending aorta with extracorporeal circulation and moderate hypothermia (32 °C). All patients underwent monitoring of cerebral and tissue oxygenation, transcranial Doppler and testing of cognitive functions before and after surgery, and after 5 and 10 years of follow-up. RESULTS: Postoperative stroke in group I was observed in 1 (2%) patient, no cases were observed in group II. Delirium was detected in 14% of patients in group I and 6% of patients in group II, its subsyndromal form was found in 6 and 4%, respectively. Moderate cognitive impairment in the immediate postoperative period was found in 42 and 26%; severe in 8% of group I. After 5 years of follow-up, the number of patients with moderate and severe cognitive impairment was 23.1 and 12.8%, respectively. After 10 years, severe disorders were identified in 37.5 and 21.9% of patients. CONCLUSION: In cardiac surgery patients, intraoperative multimodal monitoring allows dynamic regulation of antegrade cerebral perfusion. Dynamic testing of cognitive functions and early detection of delirium in the immediate postoperative period improve long-term neurological treatment outcomes.


Subject(s)
Aorta, Thoracic , Aorta , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Cerebrovascular Circulation , Humans , Perfusion , Postoperative Complications/epidemiology , Prospective Studies , Russia , Treatment Outcome
7.
Article in Russian | MEDLINE | ID: mdl-31851170

ABSTRACT

AIM: To compare the efficacy of 2% articaine solution and 2% lidocaine solution used to perform therapeutic nerve blocks of the large occipital nerve in patients with cervicogenic headache. MATERIAL AND METHODS: A randomized prospective comparative clinical study was conducted in two groups treated with articaine (n=22) or lidocaine (n=21). The therapeutic great occipital nerve blocks were performed on the 1st, 3d and 5th days of treatment. The efficacy of treatment was assessed by the pain intensity measured with the Visual Analogue scale (VAS) and the duration of individual pain paroxysms on the 5th and 10th days. RESULTS: The baseline VAS pain intensity was 6.3±1.2 and 5.9±2.0 centimeters, whereas the duration of individual pain paroxysms was 7.8±2.3 and 9.1±2.8 hours in the articaine group and the lidocaine group, respectively. By the 5th day, there was a more dramatically decrease in VAS pain intensity and duration in the articaine group (up to 3.0±0.8 and 4.3±1.2 centimeters VAS (p<0.05)) compared to the lidocaine group (up to 1.9±0.6 to 4.8±1.3 hours (p<0.05)). By the 10th day, the pain intensity did not differ between groups (1.2±0.5 and 1.7±0.7 centimeters (p>0.05)). The duration of pain episodes was still lower in the articaine group (0.5±0.08 hours) compared to the lidocaine group (2.4±0.8 hours) (p<0.05). CONCLUSION: Therapeutic large occipital nerve blocks with 2% solution of articaine show the significant decrease in pain intensity and duration of pain paroxysms in a short period of time for patients with cervicogenic headache.


Subject(s)
Anesthetics, Local , Carticaine , Lidocaine , Nerve Block , Post-Traumatic Headache , Anesthetics, Local/administration & dosage , Carticaine/administration & dosage , Double-Blind Method , Humans , Lidocaine/administration & dosage , Pain Measurement , Post-Traumatic Headache/therapy , Prospective Studies
8.
Khirurgiia (Mosk) ; (12): 5-12, 2019.
Article in Russian | MEDLINE | ID: mdl-31825337

ABSTRACT

The review is devoted to analysis of current trends in interdisciplinary approach to the differential diagnosis of patients' conditions on the first day after cardiac, ascending aortic and aortic arch surgery and repair of internal carotid arteries (neurological disorders, delirium, cognitive dysfunction, psycho-emotional disorders, postoperative sedation). This approach is valuable to determine the prognosis and timely treatment. The basic concepts reflecting the discussion between neurologists, cardiovascular surgeons, anesthetists, radiation diagnostics specialists and rehabilitators are summarized. The authors concluded that timely and correct differential diagnosis of the states on the first postoperative day using current tests and interdisciplinary approach to the treatment of patients with postoperative impaired consciousness or neurological/psycho-emotional dysfunction can improve their quality of life and efficiency of medical care.


Subject(s)
Aorta/surgery , Cardiovascular Diseases/surgery , Cardiovascular Surgical Procedures/adverse effects , Nervous System Diseases/diagnosis , Neurocognitive Disorders/diagnosis , Aorta, Thoracic/surgery , Carotid Artery, Internal/surgery , Diagnosis, Differential , Humans , Nervous System Diseases/etiology , Neurocognitive Disorders/etiology , Prognosis , Time Factors
9.
Article in English, Russian | MEDLINE | ID: mdl-31626173

ABSTRACT

AIM: To assess the dynamics of blood flow in patients with hemodynamically significant pathological kinked internal carotid arteries (PK ICA) with their orthostatic and rotational positions. MATERIAL AND METHODS: Eighty-six patients, including 35 with PK ICA due to fibromuscular dysplasia (FMD) and 51 with PK ICA due to hypertensive heart disease, and 20 healthy people were examined. All patients underwent Doppler ultrasound scanning. All indicators were evaluated in the position of the patient lying on his back and functional stress tests (orthostatic, rotational). RESULTS: The peak systolic velocity, end diastolic velocity, peripheral resistance index did not differ significantly in patients with PK ICA due to FMD and hypertensive heart disease. The increase of blood flow in bends was significantly higher with S-shaped kinking, regardless of the reason for their formation (p<0.05). In orthostatic position, significant changes of hemodynamic parameters in ICA in healthy people did not occur. Moreover, more frequent formation of turbulent blood flows in the group with hypertensive heart disease (78%) and a decrease in LBFV in the standing position were found in patients with PK ICA due to FMD. Rotational position did not alter the hemodynamics in ICA in healthy people and significantly influenced the values of LBFV in patients with PK ICA. CONCLUSION: Changes in hemodynamic parameters in the area of kinking with orthostatic and rotational positions of ICA demonstrate more significant impairments in patients with PK ICA due to hypertensive heart disease compared to patients with FMD. The rotational position of PK ICA is the most informative for identifying turbulent blood flow and an increase in peak systolic velocity in the area of kinking.


Subject(s)
Carotid Artery, Internal , Carotid Stenosis , Blood Flow Velocity , Carotid Arteries , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/physiopathology , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/physiopathology , Diastole , Hemodynamics , Humans , Regional Blood Flow , Ultrasonography, Doppler , Ultrasonography, Doppler, Duplex
10.
Khirurgiia (Mosk) ; (12): 5-12, 2018.
Article in Russian | MEDLINE | ID: mdl-30560839

ABSTRACT

AIM: To identify correlation of carotid endarterectomy with neurocognitive function and psycho-emotional state changes. MATERIAL AND METHODS: There were 120 patients with internal carotid arteries (ICA) stenoses for the period from September 2013 to December 2016. The main group consisted of 100 patients undergoing carotid endarterectomy for internal carotid artery stenosis, control group - 20 patients who refused surgery in 2014-2016. Cognitive function and psycho-emotional state were assessed preoperatively, after 24 hours, 7 days and 3, 6 months postoperatively using the Mini Mental State Examination (MMSE), Frontal assessment battery (FAB), Information-Memory-Concentration Test, Clock Drawing Test and Schulte`s test, Luria Memory Words Test, Hospital Anxiety and Depression Scale (HADS) and Covi Anxiety Scale. RESULTS: Moderate preoperative cognitive impairment was observed in 39 (39%) patients of the main group. De novo postoperative cognitive dysfunction occurred in 65 patients on the 1st day after surgery (65%). Disturbances were noted after 1 week in 26%, after 3 months - in 15%, after 6 months - in 10% of patients. Improved status was noted in 31 (31%) patients of the main group within 1 day after surgery. Improved results were observed after 7 days in 52 (52%) patients, after 3 months - in 67 (67%), after 6 months - in 78 (78%) patients. Mean values of psycho-emotional testing in the main group were high before surgery and significantly decreased on the 1st day after operation. However, advanced anxiety and aggravation of depression occurred in 14% of patients (n=14) that affected cognitive sphere (p<0.01). Progressive cognitive impairment was noted in the control group. CONCLUSION: Carotid endarterectomy has a positive long-term effect on initially impaired neurocognitive functions (3 and 6 months) (p<0.05). There were no significant differences in cognitive testing data in subgroups of eversion and classical procedures (p>0.05). Early postoperative depressive disorders significantly increase the risk of postoperative cognitive dysfunction.


Subject(s)
Carotid Stenosis/surgery , Cognition Disorders/diagnosis , Endarterectomy, Carotid/adverse effects , Carotid Stenosis/psychology , Cognition Disorders/etiology , Cognition Disorders/psychology , Depressive Disorder/diagnosis , Depressive Disorder/etiology , Humans , Neuropsychological Tests , Time Factors
11.
Article in Russian | MEDLINE | ID: mdl-28635877

ABSTRACT

Low back pain (LBP) is accompanied by the development of pain syndrome that spreads into the leg in 25-57% of patients. This is an important factor predicting the risk of transition of pain from acute to chronic and is an indirect indicator of disease severity. It is often impossible to specify the primary mechanism facilitated pain irradiation in lumboischialgia because many structures can cause analogous symptoms. Mechanisms of development of LBP are represented by nociceptive, neuropathic and psychogenic components. Currently, the term 'neuropathic back pain' remains rather ambiguous. Existing data suggest that the term 'neuropathic LBP is not confined to classic radiculopathy and is realized through several pathophysiological mechanisms. Lumboischialgia is a clinical appearance of these mechanisms. The authors present main mechanisms of the development of lumboischialgia, discuss clinical markers of neuropathic component of LBP, approaches to its diagnosis and treatment.


Subject(s)
Low Back Pain/etiology , Radiculopathy/complications , Humans , Neuralgia , Pain Measurement
13.
Article in Russian | MEDLINE | ID: mdl-25591635

ABSTRACT

OBJECTIVE: To study different methods of treatment of patients with myofascial pain syndrome (MFPS). MATERIAL AND METHODS: We evaluated the efficacy of complex treatment in 152 patients with chronic tension-type headache (СЕЕР) and 96 patients with facial MFPS. The treatment included standard methods (reflex therapy of СЕЕР and local injections of a combination of local anesthetics with small doses of steroids in trigger points in patients with facial MFPS. To assess the efficacy of tizanidine, patients were randomized into two comparable groups. The duration of the study was 12 weeks. RESULTS AND CONCLUSION: The combined therapy, including reflex action and tizanidine, speeds recovery from pain and ensures the stability of results.


Subject(s)
Analgesics/therapeutic use , Clonidine/analogs & derivatives , Myofascial Pain Syndromes/therapy , Reflexotherapy , Adult , Clonidine/therapeutic use , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Myofascial Pain Syndromes/drug therapy
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